Abstract
Giant cell arteritis (GCA) is a form a large- to medium-vessel vasculitis that involves the aorta and its branches. Polymyalgia rheumatica (PMR), a syndrome of muscle pain and stiffness in the neck, shoulders, and hips, often occurs with GCA but can occur independently. GCA predominantly affects the second- to fifth-order aortic branches, often in the extracranial arteries of the head. The mean age at diagnosis of GCA is approximately 72. The diagnosis of GCA is made usually by biopsy of the temporal artery. GCA associated with granulomatous inflammation within the blood vessel wall, but granulomatous changes are not always evident early in the disease. Giant cells occur in a slight majority of cases of positive temporal artery biopsies. Estimates of the frequency of giant cells in temporal artery biopsy tissues are on the order of 50–80%. In GCA, clinical symptoms of local vascular inflam-mation and vascular insufficiency are usually accompanied or preceded by a systemic inflammatory process. Visual loss is the most feared complication of GCA. Visual loss may occur through the syndrome of anterior ischemic optic neuropathy, caused by narrowing of the posterior ciliary artery, as well as through other arterial insufficiency syndromes. Glucocorticoids are the cornerstone of treatment for GCA and PMR. PMR occurring in the absence of GCA requires a lower dose of prednisone for disease control.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Achkar A, Lie J, Hunder G, et al How does previous corticosteroid treatment affect the biopsy findings in giant cell (temporal) arteritis? Ann Intern Med 1994;120:987–92
Allsop CJ, Gallagher PJ. Temporal artery biopsy in giant-cell arteritis: a reappraisal. Am J Surg Pathol 1981;5:317–23
Amor-Dorado JC, Llorca J, Garcia-Porrua C, et al Audiovestibular manifestations in giant cell arteritis: a prospective study. Medicine (Baltimore) 2003;82(1):13–26
Andersson R, Malmvall BE, Bengtsson BA. Long-term corticosteroid treatment in giant cell arteritis. Acta Med Scand 1986;220(5):465–9
Bley TA, Brink I, Reinhard M. [Imaging procedures for giant cell arteri-tis (Horton's disease)]. Ophthalmologe 2006;103(4):308–16
Bley TA, Weiben O, Uhl M, et al Assessment of the cranial involvement pattern of giant cell arteritis with 3 T magnetic resonance imaging. Arthritis Rheum 2005a;52(8):2470–7
Bley TA, Wieben O, Uhl M, et al High-resolution MRI in giant cell arteritis: imaging of the wall of the superficial temporal artery. AJR Am J Roentgenol 2005b;184(1):283–7
Blockmans D. The use of (18F)fluoro-deoxyglucose positron emission tomography in the assessment of large vessel vasculitis. Clin Exp Rheumatol 2003;21(6 Suppl 32):S15–22
Blockmans D. PET in large-vessel vasculitis and polymyalgia rheu-matica. In: Fourth International Conference on Giant Cell Arteritis and Polymyalgia Rheumatica, New York; 2008
Blockmans D, De Ceuninck L, Vanderschueren S, et al Repetitive 18F-fluorodeoxyglucose positron emission tomography in giant cell arteritis: a prospective study of 35 patients. Arthritis Rheum 2006;55 (1):131–7
Bongartz T, Matteson EL. Large-vessel involvement in giant cell arteri-tis. Curr Opin Rheumatol 2006;18(1):10–7
Boyev LR, Miller NR, Green WR. Efficacy of unilateral versus bilateral temporal artery biopsies for the diagnosis of giant cell arteritis. Am J Ophthalmol 1999;128:211–5
Brack A, Martinez-Taboada V, Stanson A, Goronzy JJ, Weyand CM. Disease pattern in cranial and large-vessel giant cell arteritis. Arthritis Rheum 1999;42(2):311–7
Brass SD, Durand ML, Stone JH, et al A 59 year-old man with chronic daily headaches. N Engl J Med 2008; 359(21):2267–78.
Caselli RJ, Daube JR, Hunder GG, et al Peripheral neuropathic syndromes in giant cell (temporal) arteritis. Neurology 1988;38: 685–9
Caselli RJ, Hunder GG, Whisnant JP. Neurologic disease in biopsy-proven giant cell (temporal) arteritis. Neurology 1988; 38:352–9.
Churchill CH, Abril A, Krishna M, et al Jaw claudication in primary amyloidosis: unusual presentation of a rare disease. J Rheumatol 2003;30:2283–6
Cohen MD, Ginsburg WW, Allen GL. Facial swelling in giant cell arteritis. J Rheumatol 1982;9:325–7
Duhaut P, Berruyer M, Pinede L, et al Anticardiolipin antibodies and giant cell arteritis: a prospective, multicenter case-control study. Groupe de Recherche sur l'Arterite a Cellules Geantes. Arthritis Rheum 1998;41(4):701–9
Esposito AL, Gleckman RA. Fever of unknown origin in the elderly. J Am Geriatr Soc 1978;26:498–505
Esteban MJ, Font C, Hernandex-Rodriguez J, et al Small-vessel vascu-litis surrounding a spared temporal artery: clinical and pathological findings in a series of twenty-eight patients. Arthritis Rheum 2001;44:1387–95
Evans J, O'Fallon W, Hunder G. Increased incidence of aortic aneu-rysm and dissection in giant cell (temporal) arteritis. Ann Int Med 1995;122:502–7
Font RL, Prabhakaran VC. Histological parameters helpful in recognizing steroid-treated temporal arteritis: an analysis of 35 cases. Br J Ophthalmol 2007;91:204–9
Friedman G, Friedman B. The sensation of facial swelling in temporal arteritis: a predictor for the development of visual disturbance. Postgrad Med J 1986;62(733):1019–20
Genereau T, Lortholary O, Pottier M, et al Temporal artery biopsy. A diagnostic tool for systemic necrotizing vasculitis. Arthritis Rheum 1999;42:2674–81
Gertz MA, Kyle RA, Griffing WL, et al Jaw claudication in primary systemic amyloidosis. Medicine 1986;65:173–9
Gooi P, Brownstein S, Rawlings N. Temporal arteritis: a dilemma in clinical and pathological diagnosis. Can J Ophthalmol 2008;43: 119–20
Gordon L, Levin L. Visual loss in giant cell arteritis. JAMA 1998; 280: 385–6
Graham E, Holland A, Avery A, Russell RW. Prognosis in giant-cell arteritis. Br Med J (Clin Res Ed) 1981;282(6260):269–71
Hall S, Lie J, Kurland L, et al The therapeutic impact of temporal artery biopsy. Lancet 1983;2:1217–20
Hausch RC, Harrington T. Temporal arteritis and sensorineural hearing loss. Semin Arthritis Rheum 1998;28(3):206–9
Hayreh SS, Podhajsky PA, Zimmerman B. Occult giant cell arteritis: ocular manifestations. Am J Ophthalmol 1998a;125(4):521–6
Hayreh SS, Podhajsky PA, Zimmerman B. Ocular manifestations of giant cell arteritis. Am J Ophthalmol 1998b;125(4):509–20
Hayreh SS, Zimmerman B, Kardon RH. Visual improvement with cor-ticosteroid therapy in giant cell arteritis. Report of a large study and review of literature. Acta Ophthalmol Scand 2002;80:355–67
Hellmann DB, Uhlfelder ML, Stone JH, et al Domains of quality of life important to patients with giant cell arteritis. Arthritis Rheum 2003;49(6):819–25
Hoffman GS, Cid MC, Hellmann DB, et al A multicenter, randomized, double-blind, placebo-controlled trial of adjuvant methotrexate treatment for giant cell arteritis. Arthritis Rheum 2002;46(5):1309–18
Horton BT, Magath TB, Brown GE. Undescribed forms of arteritis of temporal vessels. Proc Staff Meet Mayo Clin 1932;7:700–1
Horton BT, Magath TB, Brown GE. Arteritis of temporal vessels: report of 7 cases. Proc Staff Meet Mayo Clin 1937;12:548–53
Hunder GG, Sheps SG, Allen GL, Joyce JW. Daily and alternate-day corticosteroid regimens in treatment of giant cell arteritis: comparison in a prospective study. Ann Intern Med 1975;82:613–8
Huston KA, Hunder GG, Lie JT, et al Temporal arteritis: a 25-year epi-demiologic, clinical, and pathologic study. Ann Intern Med 1978; 88(2):162–7
Jover JA, Hernandez-Garcia C, Morado IC, et al Combined treatment of giant-cell arteritis with methotrexate and prednisone. a randomized, double-blind, placebo-controlled trial. Ann Intern Med 2001;134 (2):106–14
Karahaliou M, et al Colour duplex sonography of temporal arteries before decision for biopsy: a prospective study in 55 patients with suspected giant cell arteritis. Arthritis Res Ther 2006;8:R116
Kyle V, Hazleman B. Treatment of polymyalgia rheumatica and giant cell arteritis. II. Relation between corticosteroid dose and corticos-teroid-associated diseases. Ann Rheum Dis 1989;48:662–6
Kyle V, Hazleman BL. The clinical and laboratory course of polymyal-gia rheumatica/giant cell arteritis after the first two months of treatment. Ann Rheum Dis 1993;52(12):847–50
Kyle V, Wraight EP, Hazleman BL. Liver scan abnormalities in polymyal-gia rheumatica/giant cell arteritis. Clin Rheumatol 1991;10(3):294–7
Larson T, Hall S, Hepper N, et al Respiratory tract symptoms as a clue to giant cell arteritis. Ann Intern Med 1984;101:594–7
Lee CC, Su WW, Hunder GG. Dysarthria associated with giant cell arteritis. J Rheumatol 1999;26:931–2
Lee MS, Smith SD, Gabor A. Antiplatelet and anticoagulant therapy in patients with giant cell arteritis. Arthritis Rheum 2006;54:3306–9
Lessell S. Nonarteritic anterior ischemic optic neuropathy: enigma variations. Arch Ophthalmol 1999;117:386–8
Lie JT. Illustrated histopathologic classification criteria for selected vasculitis syndromes. Arthritis Rheum 1990;33:1074–87
Liozon E, Roblot P, Paire D, et al Anticardiolipin antibody levels predict flares and relapses in patients with giant-cell (temporal) arteri-tis. A longitudinal study of 58 biopsy-proven cases. Rheumatology (Oxford) 2000;39(10):1089–94
Lundberg I, Hedfors E. Restricted dose and duration of corticosteroid treatment in patients with polymyalgia rheumatica and temporal arteritis. J Rheumatol 1990;17(10):1340–5
Mahr AD, Jover JA, Spiera RF, et al Adjunctive methotrexate to treat giant cell arteritis: an individual patient data meta-analysis. Arthritis Rheum 2007;56(8):2789–97
Manna R, Latteri M, Cristiano G, et al Anticardiolipin antibodies in giant cell arteritis and polymyalgia rheumatica: a study of 40 cases. Br J Rheumatol 1998;37(2):208–10
Meller J, Strutz F, Siefker U, et al Early diagnosis and follow-up of aortitis with [(18)F]FDG PET and MRI. Eur J Nucl Med Mol Imaging 2003;30(5):730–6
Meyer O, Nicaise P, Moreau S, et al Antibodies to cardiolipin and beta 2 glycoprotein I in patients with polymyalgia rheumatica and giant cell arteritis. Rev Rhum Engl Ed 1996;63(4):241–7
Morgan G, Harris E. Non-giant cell temporal arteritis. Arthritis Rheum 1978;21:362–6
Nesher G, Berkun Y, Mates M. Low-dose aspirin and prevention of cranial ischemic complications in giant cell arteritis. Arthritis Rheum 2004;50:1332–7
Nuenninghoff DM, Hunder GG, Christianson TJ, et al Mortality of large-artery complication (aortic aneurysm, aortic dissection, and/or large-artery stenosis) in patients with giant cell arteritis: a population-based study over 50 years. Arthritis Rheum 2003;48(12):3532–7
Olopade, CO, Sekosan, M, Schraufnagel, DE. Giant cell arteritis manifesting as chronic cough and fever of unknown origin. Mayo Clin Proc 1997;72:1048
Papadimitraki ED, Kyrmizakis DE, Kritikos I, Boumpas DT. Ear-nose-throat manifestations of autoimmune rheumatic diseases. Clin Exp Rheumatol 2004;22(4):485–94
Paraskevas KI, Boumpas DT, Vrentzos GE, Mikhailidis DP. Oral and ocular/orbital manifestations of temporal arteritis: a disease with deceptive clinical symptoms and devastating consequences. Clin Rheumatol 2007;26(7):1044–8
Pipitone N, Boiardi L, Bajocchi G, Salvarani C. Long-term outcome of giant cell arteritis. Clin Exp Rheumatol 2006;24(2 Suppl 41): S65–70
Pipitone N, Boiardi L, Salvarani C. Are steroids alone sufficient for the treatment of giant cell arteritis? Best Pract Res Clin Rheumatol 2005;19(2):277–92
Pipitone N, Versari A, Salvarani C. Role of imaging studies in the diagnosis and follow-up of large-vessel vasculitis: an update. Rheumatology (Oxford) 2008;47(4):403–8
Pless M, Rizzo JF III, Lamkin JC, Lessell S. Concordance of bilateral temporal artery biopsy in giant cell arteritis. J Neuroophthalmol 2000;20:216–8
Porter MJ. Temporal arteritis presenting as a submandibular swelling. J Laryngol Otol 1990;104(10):819–20
Razavi M, Jones, RD, Manzel, et al Steroid-responsive Charles Bonnet syndrome in temporal arteritis. J Neuropsychiatry Clin Neurosci 2004;16:505
Regan MJ, Green WR, Stone JH. Ethnic disparity in the incidence of temporal arteritis: a 32-year expereince at an urban medical center. Arthritis Rheum 2000;43:S128
Rojo-Leyva F, Ratliff N, Cosgrove D, et al Study of 52 patients with idiopathic aortitis from a cohort of 1204 surgical cases. Arthritis Rheum 2000;43:901–7
Rucker JC, Biousse V, Newman NJ. Ischemic optic neuropathies. Curr Opin Neurol 2004;17(1):27–35
Ruiz-Masera JJ, Alamillos-Granados FJ, Dean-Ferrer A, et al Sub-mandibular swelling as the first manifestation of giant cell arteritis. Report of a case. J Craniomaxillofac Surg 1995;23(2):119–21
Salvarani C, Cantini F, Boiardi L, Hunder GG. Polymyalgia rheumatica and giant-cell arteritis. N Engl J Med 2002a;347(4):261–71
Salvarani C, Giannini C, Miller DV, et al Giant cell arteritis: involvement of intracranial arteries. Arthritis Rheum 2006;55:985–9
Salvarani C, Hunder GG. Giant cell arteritis with a low erythrocyte sedimentation rate: Frequency of occurence in a population-based study. Arthritis Rheum 2001;45:140–5
Salvarani C, Silingardi M, Ghirarduzzi A, et al Is duplex ultrasonogra-phy useful for the diagnosis of giant-cell arteritis? Ann Intern Med 2002b;137:232
Schmidt WA, Kraft HE, Vorpahl K, Volker L, Gromnica-Ihle EJ. Color duplex ultrasonography in the diagnosis of temporal arteritis. N Engl J Med 1997;337(19):1336–42
Seo P, Stone JH. Large-vessel vasculitis. Arthritis Care Res 2002;51: 128–39
Small P, Brisson M-L. Wegener's granulomatosis presenting as temporal arteritis. Arthritis Rheum 1991;34:220–3
Smetana GW, Shmerling RH. Does this patient have temporal arteritis? JAMA 2002;287:92–101
Spiera RF, Mitnick HJ, Kupersmith M, et al A prospective, doubleblind, randomized, placebo controlled trial of methotrexate in the treatment of giant cell arteritis (GCA). Clin Exp Rheumatol 2001; 19(5):495–501
Stone JH. Hearing voices. Pharos 2006;69:31–2
Stone JH. Antiplatelet versus anticoagulant therapy in patients with giant cell arteritis: which is best? Nat Clin Pract Rheumatol 2007;3: 136–7
Stone JH, Francis HW. Immune-mediated inner ear disease. Curr Opin Rheumatol 2000;12(1):32–40
Tso E, Flamm SD, White RD, et al Takayasu arteritis: utility and limitations of magnetic resonance imaging in diagnosis and treatment. Arthritis Rheum 2002;46(6):1634–42
Wilkinson IM, Russell RW. Arteries of the head and neck in giant cell arteritis: a pathological study to show the pattern of arterial involvement. Arch Neurol 1972;27:378
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2009 Springer Science+Business Media B.V.
About this chapter
Cite this chapter
Stone, J.R., Pless, M., Salvarani, C., Pipitone, N., Lessell, S., Stone, J.H. (2009). Giant Cell Arteritis and Polymyalgia Rheumatica. In: Stone, J.H. (eds) A Clinician's Pearls and Myths in Rheumatology. Springer, London. https://doi.org/10.1007/978-1-84800-934-9_27
Download citation
DOI: https://doi.org/10.1007/978-1-84800-934-9_27
Publisher Name: Springer, London
Print ISBN: 978-1-84800-933-2
Online ISBN: 978-1-84800-934-9
eBook Packages: MedicineMedicine (R0)